Provider Demographics
NPI:1467226951
Name:KACUR, R MICHAEL
Entity Type:Individual
Prefix:
First Name:R MICHAEL
Middle Name:
Last Name:KACUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2601
Mailing Address - Country:US
Mailing Address - Phone:440-731-6301
Mailing Address - Fax:
Practice Address - Street 1:2217 GARDEN DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2601
Practice Address - Country:US
Practice Address - Phone:440-731-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR232372251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health